The EEG is a key tool in the diagnosis and management of epilepsy and other seizure disorders. It is also used to assist in the diagnosis of brain damage and disease (e.g., stroke, tumors, encephalitis), mental retardation, sleep disorders, degenerative diseases such as Alzheimer's disease and Parkinson's disease, and certain mental disorders (e.g., alcoholism, schizophrenia, autism).
An EEG may also be used to monitor brain activity during surgery and to determine brain death.
Electroencephalography should be administered and interpreted by a trained medical professional only. Data from an EEG is only one element of a complete medical and/or psychological patient assessment, and should never be used alone as the sole basis for a diagnosis.
Before the EEG begins, a nurse or technician attaches approximately 16–20 electrodes to the patient's scalp with a conductive, washable paste. Depending on the purpose for the EEG, implantable or invasive electrodes are occasionally used. Implantable electrodes include sphenoidal electrodes, which are fine wires inserted under the zygomatic arch, or cheekbone; and depth electrodes, which are surgically-implanted into the brain. The EEG electrodes are painless, and are used to measure the electrical activity in various regions of the brain.
For the test, the patient lies on a bed, padded table, or comfortable chair and is asked to relax and remain still during the EEG testing period. An EEG usually takes no more than one hour. During the test procedure, the patient may be asked to breathe slowly or quickly; visual stimuli such as flashing lights or a patterned board may be used to stimulate certain types of brain activity. Throughout the procedure, the electroencephalograph machine makes a continuous graphic record of the patient's brain activity, or brainwaves, on a long strip of recording paper or on a computer screen. This graphic record is called an electroencephalogram.
The sleep EEG uses the same equipment and procedures as a regular EEG. Patients undergoing a sleep EEG are encouraged to fall asleep completely rather than just relax. They are typically provided a bed and a quiet room conducive to sleep. A sleep EEG lasts up to three hours.
In an ambulatory EEG, patients are hooked up to a portable cassette recorder. They then go about their normal activities, and take their normal rest and sleep for a period of up to 24 hours. During this period, the patient and patient's family record any symptoms or abnormal behaviors, which can later be correlated with the EEG to see if they represent seizures.
Many insurance plans provide reimbursement for EEG testing. Costs for an EEG range from $100 to more than $500, depending on the purpose and type of test (i.e., asleep or awake, and invasive or non-invasive electrodes). Because coverage may be dependent on the disorder
or illness the EEG is evaluating, patients should check with their individual insurance plan.
Full instructions should be given to EEG patients when they schedule their test. Typically, individuals on medications that affect the central nervous system, such as anticonvulsants, stimulants, or antidepressants, are told to discontinue their prescription for a short time prior to the test (usually one to two days). Patients may be asked to avoid food and beverages that contain caffeine, a central nervous system stimulant. However, any such request should be cleared by the treating physician. Patients may also be asked to arrive for the test with clean hair free of spray or other styling products.
If the patient has suspended regular medication for the test, the EEG nurse or technician should advise him when he can begin taking it again.
Being off medication for one to two days may trigger seizures. Certain procedures used during EEG may trig ger seizures in patients with epilepsy. Those procedures include flashing lights and deep breathing. If the EEG is being used as a diagnostic for epilepsy (i.e., to determine the type of seizures an individual is suffering from), this may be a desired effect, although the patient needs to be monitored closely so that the seizure can be aborted if necessary. This type of test is known as an ictal EEG.
In reading and interpreting brainwave patterns, a neurologist or other physician will evaluate the type of brainwaves and the symmetry, location, and consistency of brainwave patterns. He will also look at the brain-wave response to certain stimuli presented during the EEG test (such as flashing lights or noise). There are four basic types of brainwaves: alpha, beta, theta, and delta. "Normal" brainwave patterns vary widely, depending on factors of age and activity. For example, awake and relaxed individuals typically register an alpha wave pattern of eight to 13 cycles per second. Young
The EEG readings of patients with epilepsy or other seizure disorders display bursts or spikes of electrical activity. In focal epilepsy, spikes are restricted to one hemisphere of the brain. If spikes are generalized to both hemispheres of the brain, multifocal epilepsy may be present.
The diagnostic brainwave patterns of other disorders varies widely. The appearance of excess theta waves (four to eight cycles per second) may indicate brain injury. Brain wave patterns in patients with brain disease, mental retardation, and brain injury show overall slowing. A trained medical specialist should interpret EEG results in the context of the patient's medical history, and other pertinent medical test results.
Niedermeyer, E., and F. Lopes da Silva, eds. Electroencephalography: Basic Principles, Clinical Applications and Related Fields. 3rd ed. Baltimore: Williams & Wilkins, 1993.
Restak, Richard M. Brainscapes: An Introduction to What Neuroscience Has Learned About the Structure, Function, and Abilities of the Brain. New York: Hyperion, 1995.
Paula Anne Ford-Martin
Epilepsy—A neurological disorder characterized by recurrent seizures with or without a loss of consciousness.
Ictal EEG—Used to measure brain activity during a seizure. May be useful in learning more about patients who aren't responding to conventional treatments.